School of Nursing and Midwifery

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Open Access
Adverse pregnancy outcomes attributable to socio economic and ethnic inequalities in England: a national cohort study
(2022-03-09) Jardine, J.; Walker, T.; Gurol-Urganci, I.; Webster, K.; Muller, P.; Hawdon, J.; Khalil, A.; van der Meulen, J.; Harris, Tina
Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study Background Socioeconomic deprivation and an ethnic minority background are known risk factors for adverse pregnancy outcomes. However, there is a lack of evidence on the strength of these risk factors and on the scale of their impact. Aims/objectives We quantified the magnitude of adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities at population level in England Methods (including research design, sample, analysis and ethical approval) We used administrative hospital data to evaluate stillbirth (SB), preterm birth (PTB) and fetal growth restriction (FGR) in England between 1/4/15-31/3/17 by socioeconomic deprivation quintiles and ethnic group. Attributable fractions (AF) for the entire population and specific groups compared to least deprived and/or White women were calculated without and with adjustment for smoking and body mass index (BMI). This study was exempt from ethical review as we used routinely collected data; personal data used without individual consent was approved by the NHS Health Research Authority. Findings 1 155 981 women with a singleton birth were included. There were 4505 stillbirths (0·4%). Of liveborn babies, 69175 (6·0%) were PTBs and 22 679 (2·0%) births with FGR. 24% of SBs, 19% of PTBs, and 31% of FGR could be attributed to socioeconomic inequality. These population AFs were substantially reduced with adjustment for ethnic group, smoking and BMI (12%, 10% and 17%, respectively). 12% of SBs, 1.2% of PTBs and 17% of FGR could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking and BMI had only a small impact on these ethnic group AFs (13%, 2.6% and 19%, respectively). Group-specific AFs were especially high in the most socioeconomically deprived South-Asian women and Black women for SB (54% and 64%, respectively) and FGR (72% and 55%, respectively). Conclusions. Reducing FGR, SB and PTB rates can only realistically be achieved with midwives, obstetricians, public health professionals and politicians working together to reduce such inequalities in outcome for the most vulnerable.
Open Access
‘Art for art’s sake’ or a research methodology to engage vulnerable and often underrepresented groups in healthcare education and research.
(Elsevier, 2022-10-20) Hinsliff-Smith, K.; McGarry, Julie; Bartel, Heike; Randa, Moreoagae Bertha; Langmack, Gill
The use of arts based approaches within research and scholarly activity is relatively new but where used with sensitive topics, or with those whose voices are often not heard within dominant healthcare discourse, it is proving an effective method to engage with groups which are largely neglected within research. Methods: One such approach is by use of creative arts based activities to work with groups or individuals (Leavy, 2015), often using external facilitators or researchers who are accustomed to such approaches and methods. In the field of gender based violence researchers are frequently working with very vulnerable groups or individuals who have experienced traumatic experiences and where using conventional methods of conducting research may not provide an appropriate forum for ‘hearing stories of survivorship’ or where those who have experienced abuse may not feel that they have a voice (McGarry & Bowden, 2017). Results: The study team have gained extensive use of using arts based methods to work with survivors of sexual violence and domestic abuse – both in UK and internationally. We will describe the different approaches used by sharing examples of our work over the past 5 years that have been incorporated into healthcare education programmes with digital resources freely available online (McGarry, et al. 2015). Discussion: The overall aim is to present the range of activities involved in this methodology, to share our approach to co-production with survivors of abuse in the development of creative digital educational resources and demonstrate their use in an interactive way with the conference audience. References: Leavy, P. (2015) Method Meets Art: Arts-based Research Practice. New York: The Guilford Press. McGarry, J. and Bowden, D. 2017. Unlocking stories: older women’s experiences of intimate partner violence told through creative expression Journal of Psychiatric and Mental Health Nursing. 24, 629– 637 McGarry J., Baker C., Wilson C., Felton A., Banerjee A, (2015). Preparation for safeguarding in UK pre-registration graduate nurse education. Journal of Adult Protection. 17(6), 371-379
Open Access
A COST-EFFECTIVENESS EVALUATION OF A SERVICE USER AND CARER CO-DELIVERED TRAINING PROGRAMME FOR MENTAL HEALTH PROFESSIONALS TO ENHANCE INVOLVEMENT IN CARE PLANNING
(2019-07-02) Hinsliff-Smith, K.; Davies, L.; Camacho, E.; Bee, P.; Brooks, H.; Callaghan, P.; Grundy, A.; Meade, O.; Rogers, A.; Rushton, K.; Bower, P.; Lovell, K.; Shields, G.E.; Carter, L.A.; Fraser, C.
Open Access
Does socio-demographic profile influence awareness of potential symptoms for lung or head and neck cancers in adults over 50?
(2016-07-06) Walabyeki, Julie; Adamson, Joy; Buckley, Hannah; Sinclair, Helena; Whitaker, Katriina; Atkin, Karl; Graham, Hilary; Macleod, Una; Oviasu, Osaretin
In terms of morbidity and mortality, cancer remains a significant health problem in the United Kingdom, which has led to significant interest in both patients and professionals recognising cancer symptoms. Some studies have argued that socio-demographic inequalities may be partly responsible for differences in when cancer is diagnosed and survival. This suggests the need for improved awareness of cancer symptoms to facilitate early diagnosis and better survival, especially in marginalised and disadvantaged groups. Although there is evidence of an association between socio-economic status (SES) and the awareness of general cancer symptoms by patients, no studies have examined differences in the awareness of respiratory or head and neck cancer symptoms among people who have not yet been diagnosed with cancer
Open Access
Facilitators and barriers to early diagnosis of malignant mesothelioma (FILMM): a qualitative study of patient experiences living in England, UK
(16th International Conference of the international Mesothelioma interest group, 2023-06-26) Oviasu, Osaretin; Coleby, Dawn; Padley, Wendy; Hinsliff-Smith, K.
BACKGROUND Partly due to late presentation and diagnosis of malignant mesothelioma (MM), UK’s survival rate is below the European average [1]. To date, there has been little attention given to patients’ experiences prior to MM diagnosis as available studies have focused on their lived experiences after diagnosis [2], [3]. Therefore, to improve survival through earlier diagnosis, there is an urgent need to understand decision-making points prior to patients’ MM diagnosis. OBJECTIVES This UK based study aims to explore patients’ experiences from the moment they notice the first symptom until they receive a MM diagnosis. Primary objective • To explore the factors which affect mesothelioma patients’ diagnosis pathway from their first symptom to confirmed diagnosis from their perspective. Secondary objective • To explore patients’ understanding of the development of their symptoms, reasons for seeking medical help and the process of interaction with health care professionals METHODS This is a qualitative study using one-to-one interviews and was conducted with participants who live in England, UK. Recruitment was via two regional specialist MM outpatient clinics using a purposive sample. A total of 17 patients were recruited, consented and interviewed. The data from the interviews were analysed using framework analysis. We utilised a model of pathway to treatment [4] as a conceptual framework for conducting the interviews and for the analysis of the findings. This model identifies four stages/intervals where delay can occur in the pathway to diagnosis - Appraisal, Help-seeking, Diagnostic, and Pre-treatment intervals and provides a useful framework to describe the participants’ journey to diagnosis and clinical interventions. RESULTS Preliminary findings indicates that there were barriers and facilitators within each interval identified along the MM patients’ journey to diagnosis. Within the appraisal and diagnostic intervals, the presentation of vague symptoms that were mistaken for a less serious illness were found to be a barrier. Both the patients that presented with these symptoms and their health care professional (HCP) failed to investigate for MM at the onset thereby leading to a delayed diagnosis. CONCLUSION Our findings identify, from the patients’ perspective, areas for improvement in the interactions and decision points along the clinical pathways to confirmed MM diagnosis. Earlier symptom recognition by both patient and HCP including GPs can be used to target significant and avoidable delays along patients’ MM diagnosis pathway, thereby promoting earlier diagnosis and treatment options. REFERENCE LIST [1] Cancer Research UK, “Mesothelioma statistics,” Statistics by cancer type, 2018. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/mesothelioma (accessed Feb. 24, 2020). [2] A. Arber et al., “A research study exploring the patient’s experience during the first three months following a diagnosis of Malignant Pleural Mesothelioma,” Surrey, 2010. [Online]. Available: s.surrey.ac.uk/id/eprint/2517. [3] C. Warnock, K. Lord, B. Taylor, and A. Tod, “Patient experiences of participation in a radical thoracic surgical trial: Findings from the Mesothelioma and Radical Surgery Trial 2 (MARS 2),” Trials, vol. 20, no. 598, 2019, doi: 10.1186/s13063-019-3692-x. [4] F. Walter, A. Webster, S. Scott, and J. Emery, “The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis,” J Heal. Serv Res Policy, vol. 17, no. 2, pp. 110–118, 2012, doi: 10.1258/jhsrp.2011.010113.
Open Access
Facilitators and barriers to early diagnosis of malignant mesothelioma (FILMM): A qualitative study
(2022-03-28) Oviasu, Osaretin; Brown, Jayne; Arber, Anne
Prognosis with malignant mesothelioma (MM) is poor, yet evidence indicates a better chance of survival at earlier diagnosis. There is a shortage of research to produce evidence based guidance related to patients’ journey to mesothelioma diagnosis, which could be vital in improving earlier diagnosis and ultimately the survival rate. This is particularly important for the UK as the survival rate in the UK is lower than Europe’s average. Although, there has been an attempt to examine MM patients’ referral pathway once they present to a healthcare professional, there has been no study that has examined their entire pathway to diagnosis (i.e. from patient’ symptom awareness to diagnosis). This is particularly relevant at this period as evidence has shown the impact COVID19 has on waiting times to diagnosis for other cancers. There has been little attention to MM patients’ experiences prior to diagnosis (i.e. early symptom awareness, help-seeking decisions and subsequent treatment pathways) as available studies have focused on their lived experiences after diagnosis. It is important to understand how MM patients appraise their symptoms, present to health services with MM symptoms and the speed of the pathway from presentation and referral to diagnosis and treatment.
Open Access
Factors associated with stage at diagnosis in patients with head and neck cancer
(2017-02-23) Allgar, Victoria; Oliver, Steven; Dyson, Judith; Stafford, Nicholas; Johnson, Miriam J.; Macleod, Una; Oviasu, Osaretin
Studies have shown that diagnosis of head and neck cancer (HNC) at an advanced stage reduces the survival time compared to those diagnosed with limited disease but few have investigated the relationship of characteristics of HNC patients prior to diagnosis and stage at diagnosis. The aim of the study was to compare patients’ stage at diagnosis and their socio-demographic characteristics and experience of the pathway to diagnosis
Open Access
From Silence to Voice: A collaborative international partnership to develop a digital resource for use in clinical and education settings about sexual violence from perspectives of students, educators and survivors.
(Elseiver, 2022-10-19) Hinsliff-Smith, K.; McGarry, Julie; Bartel, Heike; Langmack, Gill; Randa, Moreoagae Bertha
Background: Gender based violence (GBV) – which includes sexual violence - is a significant global public health and societal problem, recognised as a global human rights issue by the World Health Organisation (WHO, 2017). Global estimates indicate that 1 in 3 women experience physical/sexual violence in their lifetime (WHO, 2017). GBV/SV exerts a detrimental impact not only on the lives and health of women, but also those who witness abuse and has been identified as a large scale problem in South Africa with recorded estimates that a woman is raped every seventeen seconds. The impact of GBV/SV on the physical and psychological wellbeing of those who experience abuse is wide ranging. It includes the immediate physical effects for example, physical injury as well as longer term chronic ill health as a result, acute and enduring psychological trauma, mental ill-health, alongside secondary physiological health issues such as gynaecological and sexual health (Feder et al. 2011). It is well evidenced however that healthcare professionals across the spectrum do not respond effectively often due to a lack of knowledge or professional confidence and their own values and assumptions surrounding GBV/SV (McGarry et al. 2015). Education is pivotal, and a proven means to tackle a growing global problem. This includes pre-qualifying healthcare students who are often not exposed to education about GBV/SV within their current curricula. Working with our project partners and key stakeholders in South Africa during 2019, including women who have experienced GBV/SV, the aim of this research was to engage stakeholders in the co-production of a digital e-learning resource to use across multiple healthcare disciplines on GBV/SV. Our aim is to describe the process of an international collaboration, provide the context using survey data and present the digital resource and the evaluations conducted on the application and use within education and clinical settings. References: Feder G, Davies R, Baird K, Dunne D, Eldridge S, Griffiths C, Gregory A, Howell A, Johnson, M., Ramsay J, Garcia-Moreno, C., Armin, A. (2016) The sustainable development goals, violence and women’s and children’s health (WHO) http://www.who.int/bulletin/volumes/94/5/16-172205/en/ (accessed 7.7.18) McGarry J., Baker C., Wilson C., Felton A., Banerjee A, (2015). Preparation for safeguarding in UK pre-registration graduate nurse education. Journal of Adult Protection. 17(6), 371-379 World Health Organisation (2017) Violence against women http://www.who.int/news-room/fact-sheets/detail/violence-against-women (accessed 7.7.18)
Open Access
Gay men's journeys to parenthood via surrogacy: an exploratory study of UK residents
(2016-07-03) Norton, Wendy; Hudson, Nicky; Fish, Julie; Culley, Lorraine
Metadata only
Head and Neck Cancers: Time intervals from first symptom recognition to diagnosis and the relationship with stage at diagnosis
(The Allam Lecture 2017 Cardiac imaging: The next decade, 2017-04-28) Allgar, Victoria; Oliver, Steven; Dyson, Judith; Stafford, Nicholas; Johnson, Miriam J.; Macleod, Una; Oviasu, Osaretin
The aim of the study was to improve understanding of the intervals from first symptom recognition to diagnosis for head and Neck Cancers (HNCs) and explore their relationship with stage at diagnosis
Open Access
How breastfeeding can be an emotional rollercoaster: A qualitative study of primigravid women in Lincolnshire
(2013-06) Hinsliff-Smith, K.; Spencer, Rachel; Walsh, Denis
To develop an understanding of primiparous women’s experiences and challenges of breastfeeding in the early postpartum period (6-8 weeks)
Open Access
Improving students’ engagement during synchronous teaching sessions using interactive quiz tools: A case study of undergraduate Nursing students in DMU
(2024-02-07) Oviasu, Osaretin
A component of student engagement is the students’ willingness to respond to questions or ask questions during live teaching sessions. However, there is limited evidence that identifies how anonymous participation using interactive tools influences students’ engagement during teaching sessions. Therefore, this study examined how anonymous engagement with interactive tools impacts students’ willingness to respond to questions or ask questions during a face-to-face or virtual teaching session. The theoretical basis for the study is the Landers’ Theory of Gamified Learning. The study used a mixed-method approach as data were collected from undergraduate nursing students using a questionnaire. Also, a sample of some interaction reports from an interactive tool (Slido) on how students have engaged with an interactive tool during face-to-face and virtual teaching sessions were analysed. Overall, 141 students responded, majority were female (87.9%). Most participants said they will likely ask (73%) and answer (87.2%) questions using interactive tools if their responses were anonymous. Their reasons were around their confidence, avoiding embarrassment, avoiding being judged by their peers, and the fear of asking silly questions or giving wrong answers. The results indicates that students will engage more during teaching sessions when their questions or responses are anonymous. This is especially relevant when trying to get shy or non-engaging students to engage during teaching sessions.
Open Access
Improving students’ engagement during synchronous teaching sessions using interactive quiz tools: A case study of undergraduate nursing students at a university in the United Kingdom
(2024-10-28) Oviasu, Osaretin; Coleby, Dawn; Humphrey, Sam
A component of student engagement is the students’ willingness to respond to questions or ask questions during live teaching sessions.1 However, there is limited evidence that identifies how anonymous participation using interactive tools influences students’ engagement during teaching sessions. Therefore, this study examined how anonymous engagement with interactive tools impacts students’ willingness to respond to questions or ask questions during a face-to-face or virtual teaching session. The theoretical basis for the study is the Landers’ Theory of Gamified Learning.2 The study used a mixed-method approach as data were collected from undergraduate nursing students using a questionnaire. Also, a sample of some interaction reports from an interactive tool (Slido) on how students have engaged with an interactive tool during face-to-face and virtual teaching sessions were analysed. Overall, 145 students responded, majority were female (87.6%). Most participants said they will likely ask (73%) and answer (87.2%) questions using interactive tools if their responses were anonymous. Their reasons were around their confidence, avoiding embarrassment, avoiding being judged by their peers, and the fear of asking silly questions or giving wrong answers. The results indicates that students will engage more during teaching sessions when their questions or responses are anonymous. This is especially relevant when trying to get shy or non-engaging students to engage during teaching sessions. This approach could be useful for formative assessments during teaching sessions as it gives the lecturer an opportunity to assess the students’ understanding during the session enabling them to know where to focus on for the rest of the sessions. REFERENCE: 1. Brown EA, Thomas NJ, Thomas LY. Students’ willingness to use response and engagement technology in the classroom. J Hosp Leis Sport Tour Educ. 2014;15(1):80-85. doi:10.1016/j.jhlste.2014.06.002 2. Landers RN. Developing a Theory of Gamified Learning: Linking Serious Games and Gamification of Learning. Simul Gaming. 2014;45(6):752-768. doi:10.1177/1046878114563660
Open Access
An investigation into adherence to rehabilitation and performance programs in professional football (soccer) players
(BMJ, 2021-11) Smith, Ryan
Background Adherence is a multi-faceted concept and poorly understood in professional football in relation to rehabilitation and performance programs. To offer best practice to players, an understanding of why players are undertaking such programs (adherence) is important. No research to date has examined adherence in professional football. Objective This study aimed to examine adherence in both men’s and women’s professional football players in order to better inform practice and program design. Design Qualitative research design - focus groups and questionnaires. Setting One English professional Football Club - men’s U23 team and women’s first team. Patients (or Participants) 10 men’s U23 players and 11 women’s first team players from one English professional football club. Interventions (or Assessment of Risk Factors) 10 men’s players and 11 women’s players answered a questionnaire adapted from the Sports Injury Rehabilitation Adherence Scale (SIRAS) to provide an overview of adherence rates. 9 men’s players and 4 women’s players took part in follow-up focus groups to gain a deeper understanding of the players perspectives of their adherence. Thematic analysis was conducted to examine any common themes. Main Outcome Measurements Adapted Sports Injury Rehabilitation Adherence Scale (SIRAS) with follow up focus groups. Results This study found that men’s players had a better attendance to their performance programs than women’s players. However, men’s players felt they had less input into their rehabilitation sessions compared to women’s players, despite having a better understanding of the exercises given. Common themes that emerged from focus groups that influenced adherence were financial pressures, experience, perceptions of pain, self-determination and staff relationship – these themes were common in both men’s and women’s players. Conclusions Despite differences in funding and infrastructure, both men’s and women’s professional football players identify broadly the same factors that influence adherence. Particularly, both groups felt a greater understanding of financial pressures and self-determination would allow for the fostering of an adherence culture and should be considered in future program design.
Embargo
Keeping connected. Carer experiences of staying in touch with family and friends living in care homes (UK and Canada)
(International Long-term Care Policy Network (ILPN) and Care Policy and Evaluation Centre (CPEC), 2021-10-11) Hinsliff-Smith, K.; White, Caroline; Wray, Jane; Keefe, Janice
This webinar brought together three studies on visiting and other restrictions that affected family members (often people who provided regular unpaid care) of people living in care homes. Two of the these studies focus on the perspective and experiences of the relatives, and the other on the care homes experience of implementing family visitation policies in care homes.
Embargo
Leicester Ageing Together (LAT), Qualitative Evaluation, Preliminary Reporting July 2019
(2019-07-14) Hinsliff-Smith, K.; Brown, Jayne; Patel, Naina
Aims of the Presentation Provide an overview of the qualitative evaluation, how conducted, when and where Our preliminary findings from 3 groups: beneficiaries, providers and stakeholders Implications and next direction for the draft report
Open Access
Obstetric interventions and pregnancy outcomes during the Covid-19 pandemic in England: a nationwide cohort study
(THeConf, 2022-03-09) Gurol-Urganci, I.; Waite, L.; Webster, K.; Jardine, J.; Carroll, F.; Dunn, G.; Fremeaux, A.; Harris, T.; Hawdon, J.; Muller, P.; van der Meulen, J.; Khalil, A.
Title Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: a nationwide cohort study 300 words excluding title and headings No references Background The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. The ‘indirect’ effects of these changes on maternal and neonatal outcomes are likely to be larger than the direct effects of COVID-19 infection. Aims and objective/s Comparing obstetric intervention rates and pregnancy outcomes in England during the pandemic/prepandemic periods To assess if the differences in rates varied according to ethnic and socioeconomic background. Method (must include research design, sample, analysis and ethical approval) National study of singleton births in English NHS hospitals. Births during the COVID-19 pandemic period (23/03/20-22/2/21) compared with births during the corresponding calendar period one year earlier. Hospital Episode Statistics provided data about maternal characteristics, obstetric inventions and maternal and neonatal outcomes. Multi-level logistic regression models were used with all models adjusted for maternal characteristics and COVID-19 status at birth. This study was exempt from ethical review as we used routinely collected data; personal data used without individual consent was approved by the NHS Health Research Authority. Findings: Of 948,020 singleton births 451,727 occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% versus 0.37% p-value 0.16),preterm birth and SGA birth rates were slightly lower (6.0% versus 6.1% and 6% versus 5.8% respectively, both p<0.001), and obstetric interventions were slightly higher (40.4% versus 39.1% IOL; 13.9% versus 12.9% for EL CS; 18.4% versus 17.0% for EM CS; all p<0.001). There were lower rates of prolonged maternal length of stay (16.7% versus 20.2%, p<0.001) and maternal readmission (3.0% versus 3.3%, p<0.001). There was some evidence that differences in outcomes varied according to women’s ethnic background but not according to their socioeconomic background. Conclusions Changes in obstetric intervention rates and pregnancy outcomes during the pandemic period may be linked to women’s behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels.
Open Access
Pathway to diagnosis: Lung and Head & Neck cancer patients
(2017-09-26) Chen, Hong; Allgar, Victoria; Oliver, Steven; Dyson, Judith; Stafford, Nicholas; Johnson, Miriam J.; Macleod, Una; Oviasu, Osaretin
Open Access
RESPONSES TO DISCLOSURE OF DOMESTIC VIOLENCE IN THE ED
(BMJ, 2014-08-14) McGarry, J.; Hinsliff-Smith, K.; Kench, S; Miller, P.
Objectives & Background Significant numbers of people attend ED either as a direct result of domestic violence and abuse (DVA) or related admissions, for example self-harm (Boyle et al, 2006, Boursnell and Prosser, 2010). However, effective management remains problematic and as Gibbons (2011) has highlighted DVA often goes unreported by ED staff. The recent National Institute of Health and Care Excellence (NICE) (2014) guidance Domestic violence and abuse […] has identified that front line health care professionals will have a pivotal role and responsibility in the management of DVA in the future. The aim of our research therefore was to gather evidence regarding current practice in the recognition and management of DVA within ED in order to develop recommendations for service development through the following questions: How are survivors of DVA currently identified and managed within the ED? What systems can be put into place to maximize recognition and effective support within this context? Methods A qualitative exploratory study involving in-depth interviews with ED clinical staff (n=11) and focus groups with survivors of domestic abuse (n=6) who had attended ED in order to understand experiences and identify factors influencing effective recognition and assessment within ED. A pre-piloted aide memoire was used to guide the interviews and focus groups. Data were analyzed using Framework (Ritchie and Lewis, 2012). Results Interviews identified a number of themes with clinical staff highlighting that it was emotionally and professionally ‘challenging’ to manage disclosure, expressed anxiety about ‘wanting to do the right thing’ and were cognizant of the organizational constraints of ‘managing time’. Survivors had firsthand experience of ED attendance and discussed how they did not disclose to ED staff for a number of reasons including guilt about repeated ED attendance as a result of their injuries and ‘time wasting’, not being able to respond to staff advice to ‘leave abusive partners’ and the lack of opportunity ‘privacy’ within the ED environment. Conclusion A number of barriers exist including cultural and organizational structures which mediate against effective assessment and support. The recent NICE (2014) guidelines provide a potential platform to transform effective assessment and support for survivors by ED staff. Findings of the study and implications for service and practice development will form the basis of the presentation.

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